Future Uro-technologies: Hope or Hell for Prostate Cancer Patients?

The most important danger of focal therapy is inherent with the development of new technologies encouraging the rapid spread of new techniques, shortcutting the real bottleneck of medical innovation validation: the randomized controlled trial. There is a time frame to seize the opportunity of a clinical trial for new surgical technologies, between safety validation on preclinical models and the empirical adoption of this new technique by a large surgeon community that would make it hard to compare new techniques with the original standard one. The classical example to illustrate this fact is the development of robot-assisted radical prostatectomy (RARP): no prospective randomized controlled trial had been led to compare it with open radical or laparoscopic prostatectomies in order to obtain approval of this technique. Today we probably missed the train, and it is very unlikely that a large prospective trial can be designed with clinicians and patients accepting to be included in the controlled arm of open prostatectomy while they could benefit the pretended better technique of RARP. This problem of safe and rigorous evaluation is particularly challenging for surgical techniques compared to new drug development since it requires good collaborations inside surgeons’ community.